Biopsychosocial Factors Associated with Parenting Stress in Pediatric Sickle Cell Disease

Caregivers of children with sickle cell disease (SCD) experience significant physical and emotional hardship with their child’s disease management. Little is known about the potential contributors to parenting stress in pediatric SCD. The present study aimed to identify child and caregiver biopsychosocial factors associated with disease-related parenting stress in pediatric SCD. Participants included 74 caregiver-youth dyads. Parenting stress was associated with increased child pain frequency, more missed school days, and increased healthcare utilization, and inversely correlated with caregiver mental health and social-emotional functioning. Parenting stress also partially explained the relationship between child pain frequency and healthcare utilization after controlling for parent depression and anxiety. Parenting stress may play a unique and critical role in pediatric SCD and underscore the impact parenting stress may have on youth in medical and academic settings. Further research is warranted to determine risk factors and appropriate interventions for parenting stress to improve comprehensive patient care.

     

Parenting and Conduct Problems: Moderation by Child Empathy

Child empathy was examined as a moderator of the relations between positive and negative parenting behavior and child conduct problems. Participants were 56 mother-child dyads (child age M?=?10.8 years; 64 % male) and children were recruited with a range of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Parenting was assessed by direct observations of mothers’ praise and criticism during parent–child interactions and child empathy was measured with mother report. Child conduct problems were assessed via observation and mother-report measures, and a composite variable was created. In regression analyses, child ADHD symptoms were uniquely related to child conduct problems. Second, as hypothesized, child empathy moderated the relations between parenting and conduct problems. Mother praise was negatively related to child conduct problems at lower levels of child empathy, but this relation was not significant at higher levels of child empathy. On the contrary, mother criticism was positively related to child conduct problems at high levels of child empathy, but this relation was not significant at low levels of empathy. The results suggest that different types of parenting behavior may be differentially beneficial to children, depending on their level of empathy.     

Bidirectional Effects of Parenting Quality and Child Externalizing Behavior in Predominantly Single Parent, Under-Resourced African American Families

This study investigates the bidirectional perspective of parent–child effects by examining the extent to which parenting quality predicted child externalizing behavior and vice versa. Data was collected over four time points from primary caregivers and early school age children in low-income, primarily single parent homes (N = 249, mean age of children at Time 1 = 6.41 years). Parenting quality was operationalized as primary caregiver perceptions of positive parenting, effectiveness of parenting discipline, parenting efficacy and satisfaction. Child externalizing behavior data was captured via an assessment of the frequency of externalizing behavior as reported by caregivers. We hypothesized that parenting quality and child externalizing behavior would remain stable over time and that a bidirectional relationship would be present. Data was analyzed using structural equation modeling and results indicated that child externalizing behavior predicted subsequent parenting quality, and parenting quality predicted subsequent child externalizing. Specifically, our research team found that the influence of child externalizing behavior on parenting quality decreased with time, while the influence of parenting quality on child externalizing behavior increased with time. Overall results reveal the complex transactional influences of child externalizing behavior and parenting quality in our sample. Findings support the notion that parenting quality and child externalizing behavior are interactive processes which might best be handled by continual assessment and which may be potentially strong targets for interventions.     

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.     

Mindful Parenting: A Call for Research

Interest in mindfulness-based interventions for children and adolescents is growing, but despite substantial evidence that parental distress and psychopathology adversely affects children, there is little research on how mindfulness-based parenting interventions might benefit the child as well as the parent. As an established intervention for prevention of depressive relapse, mindfulness-based cognitive therapy (MBCT) conducted with parents is an intervention that potentially could improve parent–child relationships, reduce child symptoms, and promote healthy child development. Mindful parenting interventions bring mindful attention directly to parent–child interactions and are similar but not identical to existing clinical mindfulness interventions such as MBCT. Mindfulness-based parenting interventions have an interpersonal, rather than intrapsychic focus, with particular attention given to the parent–child relationship. Preliminary research suggests that this intervention approach may reduce stress, enhance parenting satisfaction, decrease child aggression, and increase children’s prosocial behaviors. Initial evidence supporting the effectiveness of mindful parenting programs is promising and supports our call for ongoing research.     

Bidirectional Relations between Parenting Practices and Child Externalizing Behavior: A Cross-Lagged Panel Analysis in the Context of a Psychosocial Treatment and 3-Year Follow-up

In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent–child dyads (child ages 6–11) who participated in a modular treatment protocol for early-onset ODD or CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.     

More than Just the Breadwinner: The Effects of Fathers' Parenting Stress on Children's Language and Cognitive Development

Despite numerous studies on parenting stress suggesting negative influences on parent–child interactions and children's development, the majority of these studies focus on mothers' parenting stress with little or no acknowledgement of fathers. Using data from the National Early Head Start Research and Evaluation Project, this study examined (i) the effects of fathers' parenting stress during toddlerhood on children's language and cognitive outcomes when children are 3 years old (ii) whether the effects of fathers' parenting stress on children's language and cognitive development vary by child gender? Results from mixed linear models showed fathers' parenting stress predicted children's lower cognitive scores, but there were no gender differences in the effects of fathers' parenting stress on children's cognitive outcomes. In the language domain, boys, not girls, were found to be more susceptible to the effects of fathers' parenting stress. These findings indicated that fathers, in addition to mothers, should be included in early parenting research and interventions. Copyright © 2016 John Wiley & Sons, Ltd.     

Bidirectional Effects between Parenting and Aggressive Child Behavior in the Context of a Preventive Intervention

Over time, developmental theories and empirical studies have gradually started to adopt a bidirectional viewpoint. The area of intervention research is, however, lagging behind in this respect. This longitudinal study examined whether bidirectional associations between (changes in) parenting and (changes in) aggressive child behavior over time differed in three conditions: a child intervention condition, a child + parent intervention condition and a control condition. Participants were 267 children (74 % boys, 26 % girls) with elevated levels of aggression, their mothers and their teachers. Reactive aggression, proactive aggression and perceived parenting were measured at four measurement times from pretest to one-year after intervention termination. Results showed that associations between aggressive child behavior and perceived parenting are different in an intervention context, compared to a general developmental context. Aggressive behavior and perceived parenting were unrelated over time for children who did not receive an intervention. In an intervention context, however, decreases in aggressive child behavior were related to increases in perceived positive parenting and decreases in perceived overreactivity. These findings underscore the importance of addressing child-driven processes in interventions aimed at children, but also in interventions aimed at both children and their parents.     

Parenting and Anxiety: Bi-directional Relations in Young Children

Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6–7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6–7 while higher age 5 anxiety levels were associated with reductions in age 6–7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child’s anxiety symptoms.     

Improved Parental Emotional Functioning After Circle of Security 20-Week Parent–Child Relationship Intervention

This study examined the effectiveness of the attachment-based Circle of Security 20-week intervention (COS) in improving parent emotional functioning in 83 families referred to a community clinical service with concerns about their young children’s behavior. Parenting stress and parent psychological symptoms were assessed pre and post intervention and mixed design repeated measures ANOVAs were used to assess change. Severity of presenting problems was considered as a moderator. Results showed clinically significant improvements in both aspects of parent emotional functioning, with changes accounted for by for those with more severe problems at the outset. Improvements for parents were associated with improved child behavior and more positive parent representations of the child and of parenting capacity. Findings suggest the intensive COS intervention is effective in reducing parenting stress and psychological symptoms in parents of children from aged 1–7 years. Questions remain about the mechanisms of change and the direction of effects.     

Summer Treatment Program for Preschoolers with Externalizing Behavior Problems: a Preliminary Examination of Parenting Outcomes

Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M _age = 5.06 years; 82% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP (57% of which were referred by schools or mental health/medical professionals) completed a baseline and post-treatment assessment. A subsample of 90 families completed a follow-up assessment approximately 6 to 9 months after treatment completion. Parental measures of parenting stress and discipline strategies were collected across all three assessments. Observational data were also collected across all assessments during a 5-min standardized child-led play situation and a 5-min parent-led clean up task. The parenting component of the STP-PreK included a School Readiness Parenting Program (SRPP) of which the behavioral management component was implemented via a Parent-Child Interaction Therapy (PCIT) adaptation (8 weekly group sessions with 15–20 parents in each group, lack of requirement of “mastery” criteria). All parenting outcomes (both ratings and observed) significantly improved after the intervention (Cohen’s d mean effect size across measures 0.89) with all effects being maintained at the 6–9 month follow-up. These findings highlight the initial promise of our SRPP’s PCIT adaptation in targeting multiple aspects of parenting while yielding comparable parenting skills acquisition compared to traditional individual PCIT.     

Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD,Predominantly Inattentive Presentation

We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.     

Assessing Parenting Practices Through Parent-Report and Direct Observation During Parent-Training

The specific parenting domains measured by the Alabama Parenting Questionnaire (APQ) make it particularly relevant to interventions concerned with the modification of parenting practices. This study assessed the validity and clinical utility of parent reports on the APQ using observational data of parents and children (N=56, aged 4–8 years) participating in a parent training intervention for childhood conduct problems. Parent reports on the measure were found to converge well with observations of parents’ use of praise, and harsh/aversive parenting. APQ scores also reflected change in parenting practices across treatment, and were associated with clinical child outcomes. Comparisons of the five original APQ subscales with a three-factor empirically-derived form of the measure indicated greater support for the original subscales, which were found to be valid and clinically informative in the treatment of childhood conduct problems.     

Factors Associated with 3-Year Stability and Change in Parenting Behavior of Abusive Parents

We sought to examine the stability of parenting behaviors among physically abusive parents in the 3-year period between their children’s preschool and first grade years. The second purpose of the study was to identify factors that predicted the levels and rates of change in parenting behaviors. 54 parent/child dyads were recruited following substantiated physical abuse of the child and were assessed in preschool, kindergarten, and first grade. Parenting behaviors were measured by observations during Parent–Child Interactions, self-reports from parents, and child reports using a puppet interview. Potential predictors of stability and change examined were demographic factors (SES, child gender, and ethnicity) and parent characteristics (depressive symptomatology, perceptions of child behavior problems, and life stress). Multilevel modeling indicated significant fluctuations in parenting among abusive parents, and these fluctuations were generally attributable to within-person rather than between-person differences. Linear change over time was evidenced in observed positive regard, flat affect, sensitivity, and child-reported structure; changes generally were in the direction of deterioration of parenting over time. Parents’ perceptions of the severity of their children’s behavior problems predicted changes over time in parenting behaviors related to intrusiveness and structure in the home. Demographic factors and parental depression predicted change in select parenting behaviors. Overall, findings indicate instability in parenting during the developmental transition to kindergarten and wide individual differences in patterns of change in parenting. Further, parenting behavior tends to deteriorate rather than improve following substantiation of physical abuse by the child protection system.     

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.     

The Role of Parenting Programmes in the Prevention of Child Maltreatment

Child maltreatment is a major worldwide concern and continuing high rates of abuse demand action. This article examines the role of parenting programmes as a strategy to prevent child maltreatment in the population as a whole and also as a targeted intervention for parents who have abused, or are at risk of abusing, their children. We argue that a blend of universal and targeted interventions is needed to reduce the prevalence of child maltreatment. Parenting interventions that concurrently target positive parenting and effective child management skills, dysfunctional parental attributions, and increasing parents' capacity to regulate their emotions are particularly useful. A variant of the Triple P—Positive Parenting Program, known as Pathways Triple P, is discussed to illustrate the value of this approach. Contextual factors that need to be addressed in working with child protection cases are also discussed. The role of training and supervision is discussed in the context of disseminating evidence‐based parenting programmes, and future directions for research are presented.     

Higher cortisol is associated with poorer executive functioning in preschool children: The role of parenting stress,parent coping and quality of daycare

Child executive functions (cognitive flexibility, inhibitory control, working memory) are key to success in school. Cortisol, the primary stress hormone, is known to affect cognition; however, there is limited information about how child cortisol levels, parenting factors and child care context relate to executive functions in young children. The aim of this study was to examine relationships between child cortisol, parenting stress, parent coping, and daycare quality in relation to executive functions in children aged 3–5 years. We hypothesized that (1) poorer executive functioning would be related to higher child cortisol and higher parenting stress, and (2) positive daycare quality and positive parent coping style would buffer the effects of child cortisol and parenting stress on executive functions. A total of 101 children (53 girls, 48 boys, mean age 4.24 years ±0.74) with complete data on all measures were included. Three saliva samples to measure cortisol were collected at the child’s daycare/preschool in one morning. Parents completed the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P), Parenting Stress Index (PSI), and Ways of Coping Questionnaire (WCQ). The Early Childhood Environment Rating Scale – Revised (ECERS-R) was used to measure the quality of daycare. It was found that children with poorer executive functioning had higher levels of salivary cortisol, and their parents reported higher parenting stress. However, parent coping style and quality of daycare did not modulate these relationships. Identifying ways to promote child executive functioning is an important direction for improving school readiness.     

The Influence of Child Gender on the Prospective Relationships between Parenting and Child ADHD

The aims of the current study were to (i) explore the potential bidirectional, prospective relationships between parenting and child ADHD, and (ii) explore whether these relationships differed on the basis of child gender. Data were obtained from waves 1 (children aged 4- to 5-years) to 5 (children aged 12- to 13-years) of the Longitudinal Study of Australian Child (LSAC) dataset (child cohort). In order to examine dimensions of both mothers’ and fathers’ parenting, a subsample of nuclear families with mothers, fathers and children present at all waves was extracted (final sample = 1932; sons = 981, daughters = 951). Child ADHD measures included the hyperactive-impulsive subscale of the strengths and difficulties questionnaire for symptoms, and parent-report question for diagnosis. Mothers and fathers completed scales on dimensions of Angry, Warm and Consistent Parenting. A cross-lagged panel model demonstrated (i) higher child ADHD symptoms at wave 1 led to a global increase in less-than-optimal parenting at wave 2, and (ii) child ADHD symptoms and Angry Parenting shared a prospective, bi-directional relationship (whereby increases in one predicted increases in the other over time) during earlier years of development. Latent growth curve models demonstrated that increases in Angry Parenting across time were significantly predicted by increases in child ADHD symptoms. A logistic regression demonstrated that both mothers’ and fathers’ Angry Parenting at wave 1 significantly predicted an ADHD diagnosis in children at wave 3. No predictive relationships differed between child genders; thus, it appears these prospective pathways are similar for both sons and daughters.     

Objective and subjective assessments of parenting in hyperactive preschoolers

Objective: To evaluate whether the mother–child interactions of hyperactive preschool children and their typically developing peers differentially vary as a function of situational demands, and whether groupwise differences exist with respect to disciplinary practices and family lifestyles (e.g. level of parental investment, strategies for responding to child‐initiated provocation). Methods: Parenting practices were assessed via videotaped parent–child interactions and self‐report methods in mother–child dyads of 21 hyperactive preschoolers and 48 age‐matched control dyads. Results: Hyperactive preschoolers were significantly more non‐compliant during parent–child interactions. Mothers of hyperactive preschoolers exhibited more negative behaviour and less encouragement with heightened situational demands. Although few significant differences were reported regarding disciplinary practices, parents of hyperactive preschoolers reported greater levels of anger and child rearing difficulty, and perceived their children as more bothersome. Conclusions: Parents of hyperactive preschoolers may profit from interventions that are sensitive to the impact of situational changes on their behaviour and which address possible attributional biases regarding the source of parent–child discord. Copyright © 2006 John Wiley & Sons, Ltd.     

Examining the Emotional Experience of Mothers Completing an Evidence-Based Parenting Intervention: A Grounded Theory Analysis

Parenting interventions are a well-established treatment for addressing child behavior problems that have also been shown to improve parent psychosocial health. Yet, little is known about how caregiver emotional experiences change over time during treatment. In response, the purpose of this study was to explore the emotional experiences of mothers following their participation in an evidence-based parenting intervention. Researchers conducted a secondary analysis of existing qualitative data. The study sample included semi-structured interview data from 17 mothers who previously completed the GenerationPMTO parenting intervention. Data analysis followed the grounded theory approach and included a sequential process of open, axial, and selective coding using the constant comparative method. Findings indicate mothers progressed through three distinct, yet interrelated stages of emotional experience: Before PMTO, their experiences were characterized by parenting through crisis (Stage 1); during PMTO, they transitioned to crisis stabilization (Stage 2); and following PMTO, they described experiences of emerging recovery and resilience (Stage 3). Maternal emotional experiences in each stage occurred across three contextual realms: (a) the individual (intrapersonal) level, (b) the parent–child relationship level, and the broader systemic level. Results highlight the dynamic and evolving nature of maternal emotional experience throughout various stages of the intervention process and suggest how these experiences may be associated with promoting effective parenting practices and positive child outcomes.